Spiritual Health Victoria - Heart and Soul Matters

Heart and Soul Matters

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A guide To providing spiritual care in mental health settings

Foreword

In this valuable resource, Spiritual Health Victoria tackles the elusive area of spirituality in mental health work. The very word spirituality is enigmatic. Some people may be more comfortable with the word religion, or philosophy, or cultural tradition. Others may not be comfortable with any such words at all.

What makes you feel whole and real and authentic? What makes you feel connected to others? What gives your life meaning and purpose? What gives you hope? Our answers to these questions point to what matters most in our life and to what protects us. Our inner strength and wisdom can be invaluable to our recovery and survival in times of distress, illness or crisis.

Every experience of distress or illness is unique. Only the one who experiences it knows what it really feels like, and they are the only one who intuitively know the source of their own inner strength. So, in mental health care, it is vital that each person is given the opportunity to talk about that source of strength and for mental health workers to acknowledge it as deeply important in planning ways to support them.

In this booklet, mental health workers will find practical, simple guidelines to discovering and understanding the spiritual beliefs and practices of people in their care. This will assist workers in helping people to use their inner wisdom and strength to deal with their situation. It is my hope that this resource will also give greater support to mental health workers to draw on their own spirituality in their work.

Julie Leibrich

dJulie Leibrich is the author of 11 books. She has worked for 20 years as a research psychologist before becoming one of New Zealand’s first Mental Health Commissioners.

Introduction

Purpose

BMany factors contribute to good mental health. At a very basic level things like diet, sleep and exercise form a foundation for mental health and wellbeing.

In addition, a sense of feeling connected to self and others supports us to participate fully in life. When challenged by mental illness, this sense of connection which lies at the heart of being human becomes dislocated. The person with a lived experience of mental illness is often faced with the task of re-evaluating the meaning and purpose of their existence.

Spiritual care recognises this dimension of a person and supports them in their search for meaning, purpose and hope as they re-connect to themselves and others.

Within this process, people are enabled to recognise the wholeness of their life in their experience of mental illness. In this way spirituality plays an important role in helping people live with or recover from mental health issues.

This guide is intended for staff working in community and clinical services supporting people living with mental illness, their families and carers. It explains why the recognition of a person’s spirituality in their individual support plan is important to health and wellbeing outcomes. It is designed to equip staff, carers and family members with basic information to engage in conversations that involve spiritual themes.

CThis guide is intended for staff working in community and clinical services supporting people living with mental illness, their families and carers.

This guide will also review the recovery model of service delivery and make some connections to spirituality. Recovery places a renewed focus on bringing lived experience together with the expertise, knowledge and skills of the mental health workforce, and in doing so reminds us all of the important place of authentic expression. You will notice similar language and themes emerging in both spiritual care and recovery models.

The person with a lived experience of mental illness is often faced with the task of re- evaluating the meaning and purpose of their existence.

Guiding principles

Spiritual Health Victoria has adopted the following principles, which are based on emergent models and understandings of the significant factors that contribute to health, wellbeing and quality of life. More recently there has been a global move to expand measures of health and wellbeing, quality of life, human development and capabilities beyond conventional clinical and economic measures to be inclusive of the spiritual dimension.

These principles are:

spirituality is a universal phenomenon

spirituality is one of the domains of holistic health care

spiritual care is respectful of and responsive to diversity

spiritual care is integral to the provision of personcentred care

spiritual care is integral to the provision of compassionate care

spiritual care is a shared responsibility

spiritual care requires a whole of system and whole of organisation approach.

Spiritual care is a shared responsibility

EMore recently there has been a global move... beyond conventional clinical and economic measures to be inclusive of the spiritual dimension.

What is spirituality?

What is religion?

The origin of the word ‘religion’ is derived from the Latin word religio. It means to re-connect, re-establish or re-bind our links to the divine in a quest for wholeness.

Spirituality may be experienced in a quest for meaning, purpose, connection, belonging and hope. It can deepen with growing reflective capacities and selfawareness, and can become more conscious at major turning points in life. It is recognising that the human experience is a part of the whole, and our individual journey is about growing in wholeness.

Spirituality is always embedded in the unique experience and story of each person, and so is essentially individual and subjective.

Due to this subjectivity, each individual story needs to be heard, and the person’s spirituality and unique reality discerned in each encounter and context.

We can also be aware that during the course of our lives we move to different places in our spirituality. What we hold as true and important to our being may change over time.

As staff we remain mindful of this dynamic when supporting people in this aspect of their lives.

Over many centuries the word religion has come to be more associated with organised institutional faith-based expressions and the meaning of the word in modern times has taken on a narrower interpretation.

For many, religion is a helpful tool in both talking about spirituality and giving expression to it. The community of support helps care for and nurture the individual.

For others, their religious experience has been one of exclusion, alienation and disempowerment that has left them with no sense of self or connection. These experiences can be very damaging to mental health.

Staff and carers need to be aware of the differences in peoples’ experiences so that they can honour that experience and support the choices people make as they move forward in their healing journey.

GStaff and carers need to be aware of the differences in peoples’ experiences so that they can honour that experience...

“Spirituality is a dynamic and intrinsic aspect of humanity through which a person seeks ultimate meaning, purpose and transcendence, and experiences relationship to self, family, others, community, society, nature, and the significant or sacred.” (Pulchalski, 2014) p.646

How is expressed?spirituality

Spirituality can be expressed in many different ways, and is often unique to the individual. There are no specific rules and the best guide is to simply ask a person what form of expression best supports their needs.

People may develop and express their spiritual practice through the following span of traditional religious to secular activities: belonging to a faith/religious tradition and participating in associated community-based activities

ritual and symbolic practices such as lighting a candle or burning incense pilgrimage and retreats

meditation, prayer and mindfulness

reading sacred texts

sacred music (listening to, singing and playing) including songs, hymns, psalms and devotional chants

living by certain values/acts of compassion gratitude practice contemplative reading (literature, poetry, philosophy) wearing particular clothes or eating particular foods cultural or creative activities such as art, cooking and gardening engaging with and enjoying nature

activities that develop selfawareness such as yoga and breathing exercises physical activity, group or team sports and recreational activity that involves a special quality of companionship maintaining stable family relationships and friendships (especially those involving high levels of trust and intimacy) voluntary work.

It is important to be aware that some people may consider these activities central to their lives and wellbeing, but may not think of themselves as spiritual nor associate these activities with spirituality

H(adapted from Royal College of Psychiatrists, 2005).

What is spiritual care?

positions and providing trained volunteers to add to the breadth and depth of services” (Spiritual Health Victoria, 2016), p.7

In mental health settings, spiritual care is often facilitated in group settings which commonly take the form of spirituality discussion groups. These groups may be based around themes such as forgiveness, compassion or trust.

Spiritual care is not proselytising nor does it impose the workers’ beliefs or values upon the recipient. It is commonly offered in a one-to-one relationship, is person-centred and makes no assumptions about personal conviction or life orientation.

… and how is it provided?

“When faced with significant illness, many people require more than just physical care to help them cope. This care is most often delivered through attentive and reflective listening and seeks to identify the patient’s spiritual resources, hopes and needs.

JCare is provided from a multifaith and spiritual perspective offering support, comfort, spiritual counselling, faith-based care and religious services to patients and their families.

Spiritual care professionals are most often employed directly by the institution or in partnership with a faith community and are often referred to as spiritual care practitioners, pastoral care practitioners, chaplains or visiting chaplains. Faith communities across Victoria make a significant contribution to spiritual care services by funding full and part-time

When spiritual care is delivered in this way, people have the opportunity to explore what their spirituality means to them and how it can be a supportive element in their lives. For many this offers a unique opportunity to express themselves and feel seen and heard at a very deep level by their peers and workers. These groups are ideally facilitated by experienced spiritual care practitioners who are specifically trained to support all expressions of spiritual need.

Whether we provide spiritual care in a one-to-one or group setting, it offers an important opportunity for people to focus on those areas of life that give hope, meaning and purpose. People can explore a dimension of themselves which helps them make sense of their vulnerability and experience of illness. It can be an important resource to help us make sense of the different places in which we may find ourselves whilst maintaining hope for the future.

Spiritual health and wellbeing supports a sense of feeling good about oneself. We feel this when we begin to or are fulfilling our potential, attain a sense of direction in life and feel a sense of equality with others.

It is worth remembering that spirituality is important to people whether or not they have a lived experience of mental illness.

“Spiritual care is a supportive, compassionate presence for people at significant times of transition, illness, grief or loss. Spiritual care is a collaborative and respectful partnership between the person and their health care provider and is an integral component of holistic care.” (Spiritual Health Victoria, 2016), p.7

“The group helps us to connect in love and understanding with other people.”

“We get to share our humanity and it’s beautiful.” (Participants’ voices)

How does the recovery model reflect spiritual care values?

There is no single definition of the concept of recovery for people with mental health issues. But one guiding principle is hope –the belief that it is possible for someone to regain a meaningful life despite serious mental illness.

The definition of recovery that the Australian National Framework for Recovery-Orientated Practice have adopted is:

The lived experience and insights of people with mental health issues and their families are at the heart of recovery culture. The concept of recovery was conceived by, and for people living with mental health issues. Recovery describes their own experiences and journeys, and affirms personal identity beyond the constraints of their diagnoses.

The National Framework affirms the following principles:

promoting a culture and language of hope and optimism

placing the person and their mental health issues first and

viewing their life situation holistically, including being responsive to spirituality supporting personal recovery by focusing on strengths and personal responsibility

acknowledging, valuing and learning from the lived experience.

Within the paradigm of recovery, all people are respected for the experience, expertise and the strengths they contribute (adapted from Commonwealth of Australia, 2013).

The recovery model of service delivery aligns very closely to spiritual care principles: both focus on those areas of our lives that give us hope, meaning and purpose both consider the whole person(i.e. body, mind and spirit/soul)

both seek to make positive connections with others in the community

both acknowledge the journey aspect of life both support an individual’s authentic expression in the world both acknowledge and celebrate lived experience.

“Being able to create and live a meaningful and contributing life in a community of choice with or without the presence of mental health issues.”

(2013) p.2

KFurther factors that support the recovery journey include being believed in, listened to and understood.

Can spirituality protect mental health?

Spirituality for many is a deeply transformative experience that protects and supports good mental health and recovery.

Spirituality can help people maintain good mental health by: enhancing coping mechanisms by supporting such things as hope, value, meaning and purpose facilitating social integration into caring communities that create a feeling of being connected offering a system of meaning and existential coherence in the midst of suffering participation in specific activities which may offer support and protection from anxiety and depression (adapted from Swinton, 2005).

When engaged in the range of activities that make up an active spiritual life, people may develop additional resources that help support other areas of their lives to grow and flourish.

Some spiritually based skills and resources include: nurturing self-love and developing positive selfesteem, self-control and confidence

self-reflection and honesty staying focused in the present, remaining alert, unhurried and attentive

being able to rest, relax and create a still, harmonious state of mind developing greater empathy for others

finding the courage to witness and endure distress while sustaining an attitude of hope developing improved discernment, for example deciding when to speak up or act and when to remain silent and bide one’s time learning how to give without feeling drained being able to grieve and let go speedier and easier recovery, achieved through both promoting the healthy processing of loss and maximising personal potential improved relationships with self, others and with God/ creation/nature

a new sense of meaning, resulting in the reawakening of hope and peace of mind, enabling people to accept and live with problems not yet resolved (adapted from Royal College of Psychiatrists, 2005).

LSpirituality for many is a deeply transformative experience that protects and supports good mental health and recovery.

Recognising spiritual needs

The role for mental health staff is to ascertain how people cope with new and unfamiliar situations, how their spirituality may have been a resource to them in the past and how it plays a role in their recovery journey.

The following questions are adequate to start a conversation into the spiritual dimension of a person’s life.

A good way to begin is simply to ask, “what sustains you?” or “what keeps you going in difficult times?”

A person’s answer to this question usually indicates their main spiritual concerns and pursuits.

There are two aspects to look at:

1. What helpful inner personal resources can be encouraged?

2. What external supports from the community, specific faith tradition or other sources of connection are available to the person? (Adapted from National Health Service, 2009)

The aim is to help people find the language to express themselves authentically and identify resources that will assist in their recovery. This process can have important therapeutic value.

It is important to ask these questions on an on-going and continuous basis as a person’s spiritual concerns may change over time.

The spiritual dimension of a person offers an important window into their search for meaning, love and relatedness, forgiveness and hope. Identifying these spiritual needs offers a pathway to meeting these needs. The information gained from a person is then recorded in the individual recovery care plan so that all staff share an awareness of a person’s spiritual needs and resources.

Some important things to note: determine if God is a helpful influence or a judging presence in the person’s life when a person puts God into the conversation, it is logical that they will want God to be part of the care support they

receive – to determine what this support may look like, the worker simply needs to ask the person what will work best for them, remembering that individual preference and need varies

be aware that a person with a lived experience may be troubled by their beliefs and this may lead them to behave strangely at times or seek help

A spiritual care practitioner is able to undertake a more in-depth assessment upon referral. They would utilise specific spiritual care assessment tools, listed in the reference section at the end of this guide. a What sustains you?

Responding to spiritual needs

Spiritual care is an invitation to see the world and be with people in a way that is sensitive to their inner experience.

We can actively support people by:

considering the spiritual beliefs and needs of the person in their initial assessment, upon entry into the service and for the duration of their care, treatment and engagement with the service encouraging people with a lived experience to explore what is important to them spiritually, noting this in care plans and reminding them of their value as a self-help strategy offering opportunities and encouragement to make sense

of and derive meaning from experiences, including illness experiences – this is achieved by listening carefully to a person’s story

being aware that people express their spirituality in many different ways and spiritual beliefs can influence the decisions they make about the treatment they receive, or how they want to be supported setting limits with people; complying with every request or continuing long and repetitive conversations may not be helpful; as with other areas of

mental health work, spiritual care requires the maintenance of good boundaries to provide safety for the person giving everyone the opportunity to speak to a spiritual care practitioner, chaplain or community faith leader –people who do not regard themselves as spiritual or religious may welcome this option providing an environment for purposeful activity such as creative art, structured work, enjoying nature and including these activities in individual recovery care plans and reviews making a room or space available where people can sit quietly, reflect, worship, pray or talk with others

being sensitive to cultural differences and mindful of the significance of various cultural and community days which may indicate a day of celebration or remembrance for some

being aware that some people have struggled with aspects of their identity, and this may have impacted their sense of self and connection to both people and the sacred –exercising sensitivity to spiritual issues maybe particularly important in these instances, for example members of the LGBTIQ community (adapted from Mental Health Foundation, 2007).

Relationship is the most important tool you have for working with people. Be mindful that the quality of your presence will be felt by the person as they share their story with you.

QCaring for the whole person, including heart and soul, really does matter.

Psychosis or spiritual experience? mental illness is

“It is easy to forget that mental illness is a deeply personal and meaningful event in a person’s life before it becomes a diagnosis. Diagnoses give formal structure to a personal experience but they do not (or should not) define the nature of that experience. Mental illness brings about changes in people’s lives; events which often challenge people to think about certain aspects of their lives quite differently. Sometimes these changes are pathological, at other times they are transformative and deeply spiritual.” (Swinton, 2005), p.4

For many people with a lived experience of mental illness, there is a tendency to see the world in a very fluid way. They have an ability to embrace the

whole of life – nature, divinity, mystery, fantasy and indeed the more mundane of the human experience, as one. For some, there is no boundary between the visible/invisible or human/divine, and all can exist in a world that represents a rich tapestry of life.

People with psychosis may hold unusual beliefs (delusions), describe hearing voices (auditory hallucinations) or have other experiences that seem out of touch with reality. It is worth remembering that people who are mentally well may also describe similar kinds of experiences. Some people have spiritual experiences that may seem like psychotic symptoms, for instance believing in angels or hearing the voice of their god.

a deeply personal and meaningful event

When someone who has always held such beliefs becomes unwell, these experiences are not necessarily symptoms of their mental illness (adapted from Mental Health Foundation, 2007).

Whether or not such experiences are a symptom of psychosis (delusions, loosening of associations and illogical systems of thought), staff need to respond sensitively to people who describe these experiences or who are in a state of heightened awareness.

Being open minded shows respect for a person and their spiritual beliefs. Encouraging people to talk about their experiences gives them an opportunity to be heard and understood. This may also help to reduce any distress they feel. As people share their stories with others, they name and shape the meanings of their own unique experiences.

Generally spiritual and religious experiences:

are not distressing to the individual are deeply moving and provide comfort do not require treatment or intervention can be transformative –‘a kind of rebirth’ can include unusual experiences where visual, auditory or kinaesthetic perceptions may be altered. There will be times when spiritual beliefs will not be sufficient to relieve all of a person’s distress, especially if it has progressed in severity. Professional mental health support will be needed to help a person return to a safe state, where they can once again use their spiritual resources to stay well.

An opportunity to be heard and understood

Staff needs

Historically, staff working in mental health services have overlooked spirituality. This may have occurred in the past, because services have been traditionally aligned to the ‘medical model’ which views mental health problems as caused by biological factors. This has left little room for spirituality. Most staff have not received any training in this area, so as a worker you may initially feel in unfamiliar territory when discussing spirituality with the people you support.

Talking about spirituality may also touch something personal in you as well as those in your care. This can be difficult and sometimes uncomfortable. It is helpful to respect your own feelings and reactions. They are yours and have something to tell you about what is going on within you and around you.

Understanding your own beliefs and values, and acknowledging their importance to you can help you understand and respect the key role that spirituality may play in a person with lived experience. For many, spirituality will be central to their existence, and therefore play a huge part in their recovery. As touched upon earlier, spirituality helps to shape a person’s identity and therefore will contribute in important ways to how they cope with their current problems.

Practical things you can do to support yourself include: seeking out supervision opportunities that offer you the chance to develop your understanding of the relationship between spirituality and mental health, to talk about your experience or concerns, get support, or ask for advice and request further training

getting together with your colleagues to talk about your own spiritual beliefs and needs – asking yourself the questions you ask those in your care may help you appreciate the different forms that spiritual belief can take if your health care service employs a spiritual care practitioner, seeking them out for a conversation or making links with community faith leaders (adapted from Mental Health Foundation, 2007).

vSpiritual care: creating more compassionate, person-centred health care.

References More information

Commonwealth of Australia. (2013). National Framework for Recovery-Orientated Mental Health Services: A Guide for Practitioners and Providers.

Leibrich, J. (2015). Sanctuary, the discovery of wonder. Dunedin: Otago University Press.

Mental Health Foundation. (2007). Making space for spirituality, How to support service users. London: Mental Health Foundation.

National Health Service. (2009). Spiritual Care Matters. Scotland: NHS Education for Scotland.

Puchalski, C. R. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Pallativer Medicine, 3: 129-37.

Pulchalski, C. V. (2014). Spiritual Dimensions of Whole Person Care: Reaching National and International Concensus. Royal College of Psychiatrists. (2005). Spirituality and Mental Health. Mental Health Information, 1-6.

Spiritual Health Victoria. (2016). Spiritual Care in Victorian Health Services: Towards Best Practice Framework. Melbourne: Spiritual Health Victoria. Swinton, J. (2005). Why Psychiatry Needs Spirituality, 1-10. Edinburgh.

Spiritual Health Victoria

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